Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea (Republic of).
Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea (Republic of).
Strahlenther Onkol. 2020 Feb;196(2):132-141. doi: 10.1007/s00066-019-01488-9. Epub 2019 Jul 8.
To investigate the efficacy of radiation dose escalation in patients with hepatocellular carcinoma (HCC) after incomplete transarterial chemoembolization (TACE).
This study evaluated retrospective data of 323 HCC patients who received radiotherapy after incomplete TACE from 2001-2016. Radiation dose in biologically effective dose (BED) (α/β = 10) was categorized as <72 Gy (261 patients) and ≥72 Gy (62 patients). Simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) was used significantly more frequently in the high-dose group (64.5% vs. 12.9%; P < 0.001). Local failure-free rate (LFFR), progression-free rate (PFR), and toxicities were compared between the two groups. Additionally, propensity score matching was performed.
Median follow-up time for patients who were alive at the time of analysis was 47 months (range 18-189 months). Median overall survival after radiotherapy was 14 months. In multivariate analysis, BED ≥72 Gy was an independent predictor of favorable LFFR (hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.14-0.72; P = 0.006) and PFR (HR 0.67; 95% CI 0.45-0.98; P = 0.04). In the propensity score-matched cohort (62 pairs), 1‑year LFFR (94% vs. 81%; P = 0.002), and 1‑year PFR (49% vs. 42%; P = 0.01) were significantly higher in the high-dose group. Treatment-related toxicities were comparable between the high-dose and low-dose groups (classic radiation-induced liver disease: 5.3% [3/57] vs. 13.8% [29/210], P = 0.08; grade 2-4 gastrointestinal bleeding: 3.2% [2/62] vs. 7.3% [19/261], P = 0.39).
Radiation dose with BED ≥72 Gy improved LFFR and PFR without increasing toxicity. In radiotherapy for incomplete TACE of HCC, dose escalation using SIB-IMRT should be actively considered to improve oncologic outcome.
研究经不完全经动脉化疗栓塞（TACE）后肝癌（HCC）患者放射剂量递增的疗效。
本研究评估了 2001 年至 2016 年间接受不完全 TACE 后接受放疗的 323 例 HCC 患者的回顾性数据。生物有效剂量（BED）（α/β=10）中的辐射剂量分为<72Gy（261 例）和≥72Gy（62 例）。高剂量组（64.5%比 12.9%；P<0.001）更频繁地使用同步整合增强-调强放疗（SIB-IMRT）。比较两组间局部无失败率（LFFR）、无进展率（PFR）和毒性。此外，还进行了倾向评分匹配。
在分析时存活的患者中位随访时间为 47 个月（范围 18-189 个月）。放疗后中位总生存期为 14 个月。多变量分析显示，BED≥72Gy 是 LFFR（风险比 [HR] 0.32；95%置信区间 [CI] 0.14-0.72；P=0.006）和 PFR（HR 0.67；95%CI 0.45-0.98；P=0.04）良好的独立预测因子。在倾向评分匹配队列（62 对）中，高剂量组 1 年 LFFR（94%比 81%；P=0.002）和 1 年 PFR（49%比 42%；P=0.01）明显更高。高剂量组与低剂量组的治疗相关毒性相当（经典放射性肝损伤：5.3%[3/57]比 13.8%[29/210]，P=0.08；2-4 级胃肠道出血：3.2%[2/62]比 7.3%[19/261]，P=0.39）。
BED≥72Gy 的放射剂量可提高 LFFR 和 PFR，而不增加毒性。在不完全 TACE 治疗 HCC 的放射治疗中，应积极考虑使用 SIB-IMRT 进行剂量递增，以提高肿瘤学结果。
